May 16, 2023

Medical auditor

  • Humana
  • Tampa, FL, United States
(CPMA) Certified Professional Medical Auditor

Job Description



Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Conviva and CenterWell a wholly-owned subsidiaries of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we’re seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole.


The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Your responsibilities require you to review medical data and document any areas where the medical documentation could improve in terms of accuracy and efficiency.

This is a Work from Home position

Schedule: Mon-Frid, 7am-4pm or 8am-5pm

Essential Functions
  • Verifies and ensures the accuracy, completeness, specificity, and appropriateness of medical record documentation based on a patient’s documented medical conditions
  • Confirms appropriate diagnosis and procedure code assignment, in accordance with all applicable coding guidelines
  • Utilizes electronic tools (i.e., spreadsheets) that have been created based on the CMS-HCC model and established coding guidelines
  • Prepares written summaries of audit findings
  • Presents verbal audit feedback and provides education upon completion of the medical record audit
  • Responds to or clarifies internal requests for information
  • Supports and participates in process and quality improvement initiatives
  • Partners with business associates from other departments to understand their needs and concerns, and participate in the development of system solutions
  • Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas
  • Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
  • Follows established guidelines/procedures
  • Assists in other coding capacities as needed
Required Qualifications
  • Outpatient coding experience, preferably in a risk adjustment setting
  • Passionate about contributing to an organization focused on continuous improvement
  • Proficient verbal and written communication skills
  • Proficient in all Microsoft Office applications, including Word and Excel
  • Public speaking / group presentation skills
  • Ability to travel locally and nationwide 10-15%
Preferred Qualification
  • CDEO
  • Bachelor’s Degree
  • Experience with ECW (Electronic Medical Records)
  • Outpatient auditing experience, preferably in a risk adjustment setting
Other Notes
  • Works from a corporate office or WAH, depending on the markets and locations assigned
  • May require travel within the assigned market or to corporate offices

CenterWell, a subsidiary of Humana, values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from with instructions to add the information into the application at Humana’s secure website.


We offer tangible and intangible benefits such as medical, dental and vision benefits, 401k, tuition reimbursement, vacation, paid holidays, work-life balance, growth, a positive and fun culture and much more.

Additional Information

Associates are required to be fully COVID vaccinated, including booster, or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home.

If Progressed To Offer, Candidates Will Be Required To
  • Provide proof of full vaccination, including booster OR
  • Provide proof of applicable exemption including any required supporting documentation
Medical, religious, and state exemptions will be available.

Scheduled Weekly Hours